Saturday, February 11, 2012

NYT: Taking Care of His Adopted Country, One Emergency at a Time

WHEN Dr. Raed Arafat resigned last month as under secretary of state at Romania’s Ministry of Health, thousands took to the streets across the country to demand his return. The demonstrations turned violent as protesters set fires and threw paving stones and the police responded with tear gas and water cannons.

That it was not the usual reaction, here or anywhere else, to the departure of a government official is a reflection on Dr. Arafat, a Palestinian by birth, who is no ordinary federal employee. He was one of the founders of the country’s widely lauded emergency-response system, and the reason for his departure from the ministry was as public as it was ugly.

When Dr. Arafat (no relation to the former Palestinian leader Yasir Arafat) appeared on a television talk show in January to discuss government plans for a health care overhaul, President Traian Basescu telephoned the program and berated him on the air, accusing the doctor of lying when he had said the government wanted to destroy the emergency system he had spent most of his career building.

Shocked by the ensuing protests, the president backed down and Dr. Arafat agreed to return. “I’m married to emergency medicine,” said Dr. Arafat, 47, who lives alone.

While he was out of his office for only a week, the protests continued, and grew to reflect a broader discontent with wages and pensions, with employment prospects and corruption. This week the discontent claimed Prime Minister Emil Boc, who resigned for what he said was the stability of the country.

Shortly after the fall of Communism in Romania in 1990, Dr. Arafat traveled to Regensburg, Germany, to buy a used emergency vehicle with a defibrillator and resuscitation kit, purchased with the help of friends from the German Red Cross. The young Palestinian doctor drove the car, an Opel Kadett painted with white and orange stripes and capped with blue lights, back to Romania, where he was working on a specialty in anesthesiology.

The beginnings were humble, but the result was not.

The Mobile Emergency Service for Resuscitation and Extrication now has 170 first-responder teams, 12 training centers and 4 helicopters, with a fifth on the way this spring. It is widely viewed here as one of the only parts of a broken health system functioning at a top-notch level.

“At its best, the system is better than what we have, and at its worst it’s certainly still better than what exists in lots of the United States,” said Peter Gordon, an emergency physician at Bassett Medical Center in Cooperstown, N.Y., who worked over the course of nearly a decade with Dr. Arafat to help build the system.

“His attitude is, ‘We can do it better than anywhere in the world,’ ” Dr. Gordon said. “It’s, ‘Let’s not be as good as the Germans, as good as the French, let’s be even better.’ ”

THOUGH he became a Romanian citizen in 1998, the fact that he was an immigrant, working for an adopted country rather than his native land, added to the sense of selfless sacrifice. “Nobody is a prophet in their own house, in their own homeland,” Dr. Arafat said.

Bald, with his remaining hair clipped extremely short on the sides, Dr. Arafat is intense and assertive without being aggressive or overbearing. He gives the impression of someone you would want in the back of an ambulance if you had a heart attack. More often, his volunteer shifts are on one of his agency’s helicopters, where, he said, patients sometimes recognize him if they are conscious. “ ‘It’s Dr. Arafat,’ they say.”

As a boy growing up in the West Bank, Dr. Arafat had memorized the book “First Aid Without Panic” cover to cover, learning “every page, every picture by heart,” he said. Born in Damascus, Syria, and raised in Nablus, West Bank, he described his attitude as “medicine by any means.” At the age of 14 he not only rode with the fire department on emergency calls, but also began teaching the firefighters techniques he had learned from his well-thumbed first aid manual.

By 15 he had begun volunteering at the hospital in Nablus, where he was allowed to give tetanus shots and stitches under professional supervision. His neighbor was a surgeon and head of one of the hospitals, and he spent his school vacations helping out in the operating room.

Young Raed was also accepted by a university in the United States. If not for his parents’ intervention, his future would have turned out quite differently, in a country that could have used his talents but certainly did not need them as badly as Romania. His parents were afraid that if he studied in America, he would stay for good. They did not tell him about the acceptance letter.

Instead he left in 1981, barely 17 years old, for Romania. At the time, his parents were right. “If the regime hadn’t changed, I wouldn’t have stayed at all,” Dr. Arafat said. He studied first in Cluj and then pursued a specialty in anesthesia and critical care in Targu Mures, a city of around 150,000 in Transylvania.

In the autumn of 1989, one government after another collapsed in Eastern Europe. The historic year culminated in Romania with the execution of Nicolae Ceausescu and his wife in December.

IT was shortly thereafter that Dr. Arafat made his trip to purchase the secondhand Opel Kadett. “I never thought that we would get to where we are now,” he said. “The initial idea was to create a single team of mobile intensive care based on models I have seen in France and Germany.”

At a time of upheaval throughout Eastern Europe, the young doctor worked tirelessly to set up a modern and effective emergency-medical system in a country where ambulances were barely more than taxis for the sick. His father had died and left him a small inheritance; Dr. Arafat lived off the money for the next eight years, from 1990 to 1998, as he worked as a volunteer.

And then this year, just as Dr. Arafat established operations in every district in Romania, the government announced plans to privatize the agency, part of an overhaul of the health care system. After years living under an austerity regimen meant to comply with the terms of an International Monetary Fund bailout and to put the country back on sound financial footing, Romanians drew the line at government proposals to tinker with Dr. Arafat’s emergency health service.

“It is not just about him, but it woke people up,” said Gabriel Deliu, 36, a former officer in the Romanian Army who took part in the protests, which continued for several days after Dr. Arafat agreed to take up his post again. “Otherwise people will get in an ambulance and they will say, ‘What is your account number? Do you have a credit card?’ ”

But the same qualities that made him a hero to the protesters, his political independence and dedication to medicine, meant that he had no interest in leading a political movement. “No way,” he insisted. “I said it. Never. No politics.” Dr. Arafat said he had a very good discussion with the prime minister at the time and the president (who said they had been misinformed about the emergency-response component of the proposed health care overhaul) before deciding to return to office, and noted that he had worked well with five different health ministers in two governments.

He seemed to be relieved to be back on the job. “It’s a passion,” Dr. Arafat said. “Sometimes you shouldn’t ask someone, ‘Why do you like this?’ You cannot ask a sports person, ‘Why do you like sports?’ and you cannot ask, ‘Why do you like emergency medicine?’ ”